Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Department of Medicine, Division of Cardiology, UCSF Medical Center, University of California San Francisco, San Francisco, California, USA.
Echocardiography. 2024 Jan;41(1):e15751. doi: 10.1111/echo.15751.
The effect of trastuzumab therapy on left atrial (LA) function remains largely unknown. Our aim was to assess the changes in LA strain parameters longitudinally in patients treated with trastuzumab.
We retrospectively studied 170 patients with stage I-IV HER2+ breast cancer. All patients had baseline echocardiograms and repeat echocardiograms at 3 months and after 1 year. We measured LA strain at all three time points. Changes in LA strain and strain rate (sr) parameters were evaluated using repeated-measures mixed-effects models. The cohort was stratified according to development of cancer therapeutics-related cardiac dysfunction (CTRCD) during follow-up.
The mean age was 52.7 ± 13.8 years, 25.3% had hypertension and 16.0% had metastatic disease. Multiple LA strain parameters (predicted delta value, [95%CI]) showed statistically significant declines in patients who developed CTRCD from baseline to the 3-month follow-up after multivariable adjustment; LA reservoir strain (LAε ): -4.7%; [-8.1% to -1.3%], p = .007; LA conduit strain (LAε ): -2.8%; [-5.3% to -.4%], p = .021); and LAε sr: -.2/s; [-.3/s to -.09/s], p < .001). In patients who did not develop CTRCD, LA strain parameters declined significantly but to a smaller degree than in the CTRCD group (LAε : -1.7%; [-3.1% to -.3%], p = .020, LAε : -2.2%; [-3.3% to -1.1%], p < .001, and LA booster pump strain : -2.4%; [-3.5% to -1.4%], p < .001). LA strain rates did not decline significantly in the non-CTRCD group.
Trastuzumab treatment was associated with declines in LA strain parameters in patients with breast cancer. The largest declines were observed in patients who developed CTRCD during treatment.
曲妥珠单抗治疗对左心房（LA）功能的影响在很大程度上尚不清楚。我们的目的是评估接受曲妥珠单抗治疗的患者 LA 应变参数的纵向变化。
我们回顾性研究了 170 例 HER2+期 I-IV 期乳腺癌患者。所有患者均进行基线超声心动图检查，并在 3 个月和 1 年后重复进行超声心动图检查。我们在所有三个时间点测量 LA 应变。使用重复测量混合效应模型评估 LA 应变和应变率（sr）参数的变化。根据随访期间是否发生癌症治疗相关心脏功能障碍（CTRCD），对队列进行分层。
患者的平均年龄为 52.7±13.8 岁，25.3%患有高血压，16.0%患有转移性疾病。经过多变量调整后，从基线到 3 个月随访时，发生 CTRCD 的患者多个 LA 应变参数（预测差值，[95%CI]）显示出统计学上的显著下降：LA 储备应变（LAε）：-4.7%；[-8.1%至-1.3%]，p=0.007；LA 传导应变（LAε）：-2.8%；[-5.3%至-.4%]，p=0.021]；和 LAε sr：-0.2/s；[-0.3/s 至-0.09/s]，p<0.001）。在未发生 CTRCD 的患者中，LA 应变参数也显著下降，但下降程度小于 CTRCD 组：LAε：-1.7%；[-3.1%至-.3%]，p=0.020；LAε：-2.2%；[-3.3%至-1.1%]，p<0.001；和 LA 助推泵应变：-2.4%；[-3.5%至-1.4%]，p<0.001）。非 CTRCD 组的 LA 应变率无显著下降。
曲妥珠单抗治疗与乳腺癌患者 LA 应变参数的下降有关。在治疗期间发生 CTRCD 的患者中观察到最大的下降。
